gms | German Medical Science

Objectives/Interrogation: Distal radius fracture nonunion is uncommon, occurring in less than 1% of fractures. Healing problems in the distal radius seem to be related to unstable situations, such as concomitant fracture of the ulna, and to an inadequate period of immobilization.

Methods: A 60-years old female was presented into our department with a distal radius fracture (23-A2 of OTA classification) of her right wrist. According to the characteristics of the fracture cast immobilization was applied. After removed it, she complained about pain at pronosupination movement and physical examination revealed pain at the triangular fibrocartilage complex (TFCC). 3 months later, NMR showed no signs of consolidation of distal radius fracture and a rupture of fibrocartilage type 1B of Palmer classification. We performed a correction osteotomy of the distal radius length. In addition, arthroscopy was performed showing normal status of TFCC. Rehabilitation program was completed, and she complained about persistent pain at distal radioulnar joint (DRUJ). We decided to perform a shortening osteotomy of the distal ulna by an acquired ulnar impaction, 1 month later, radiographs showed a rupture of the osteosynthesis plate and screws. CT scan confirmed the diagnosis of non-union. Osteosynthesis plate was removed and curettage, bone graft substitute and new osteosynthesis with longer plate was performed. 8 months later, CT scan showed complete consolidation of ulna osteotomy but no signs of union at radius. Ulna plate was removed and debridement of the focus fracture with autologous iliac cancellous bone graft was performed, 8 months later, the patient achieve good functional outcome and no pain was documented.

Results and Conclusions: Nonunion should be suspected if there is continuing pain after immobilization in combination with a progressing deformity. The low incidence of distal radius nonunion can be attributed to many factors, including impact of the fracture fragments, their location in the metaphyseal bone, and the fact that they typically result from low-energy falls, indicating less soft-tissue disruption. The main surgical procedure for nonunion distal radius is open reduction, freshening of nonunion, iliac crest bone grafting to achieve as much radius length as possible and stable internal fixation using a plate construct.

Non-union of distal radius fracture is rare. Carefully planned open reduction and fixation can help to achieve rapid bone union with satisfactory functional outcome.